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Histologic study of the subcutaneous hyaluronidase treatment for vascular filler complications
Ki-Hyun Cho, MD, MSc; Sayf Said, MD; Christopher C. Surek, DO; James E. Zins, MD
Cleveland Clinic Foundation, Department of Plastic Surgery
2018-02-15
Presenter: Ki-Hyun Cho
Affidavit:
Dr. Cho has assembled the design, execution, and write-up of this study under my mentorship. Data collection and interpretation was assisted by the other authors on this paper.
Director Name: James E. Zins
Author Category: Fellow Plastic Surgery
Presentation Category: Basic Science Research
Abstract Category: Aesthetics
Background: Subcutaneous hyaluronidase (HYAL) injection is the recommended treatment for the vascular complications caused by the intra-arterial injection of the hyaluronic acid (HA) filler. However, there has been no previous human study to provide the histologic evidence of its effect.
Objective: To verify the degradation of the intravascular HA filler by subcutaneous HYAL injection on a microscopic scale.
Methods: The supraorbital region was subcutaneously dissected in four fresh cadavers, followed by cannulation of the superficial branch of the supratrochlear artery. The artery was injected with the HA filler mixed with methylene blue. 5x5-mm tissue blocks were injected subcutaneously with 1.5 ml of 0.9% normal saline as a control specimen and 300 USP units of HYAL (Vitrase®, Ovine, Bausch & Lomb) as an experimental specimen respectively. Both samples were obtained after 24 hours for the hyaluronan binding protein (HABP) fluorescent staining.
Result: Hydrolysis of the intravascular HA was successfully demonstrated in two of four cadavers. In the other two cadavers, the vessels were unsuccessfully injected. Control specimens showed fine granules of HA highlighted with green fluorescence present in the vessel lumen. In contrast, experimental specimens showed less proportion of HA and demonstrated remarkably reduced areas of green fluorescence in the arterial wall. Our findings revealed a remnant HA inside the vessel even after 24 hours of HYAL treatment.
Conclusion: Our study demonstrated the hydrolysis of the intravascular HA filler by subcutaneous HYAL injection on a microscopic scale. Future studies will further document what we have found in our preliminary study.
